PFI2018-00035 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00035
s
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 02/20/2018
Parcel: SEG1384
Jurisdiction: Tigard
Site address:
Subdivision: tn,~1p Lot:
Project: PGE 1381 rSC S_`� 33
Project Description: SEG13�associated with address 13170 SW Pacific Highway. Replace bad order pole. PGE Job
M2334339.
Owner: FEES
Description Date Amount
PFI Permit Fee 02/15/2018 $300.00
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
BRANDON HADLEY
10800 SW AVERY ST
TUALATIN, OR 97008
PHONE: 503-612-2935
Total $300.00
Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact
information of responsible parties before beginning work.
Permittee/Applicant
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00035
Type: Condition Name: Status: Severity:
PFI_Utilities 01 -WORK SITE REQUIREMENTS Applied Notice
Applicant must comply with all applicable provisions of federal and state law; the Tigard Municipal Code, and the terms of
any agreement with the City of Tigard regarding work to be done pursuant to this permit.
PFI_Utilities 02-WORK SITE AREA Applied Notice
The work area and approach roads shall be maintained in a clean condition, free from obstructions and hazards. The
spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited
and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up
and suspension of work to accomplish clean-up.
PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice
Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean
Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to
accomplish effective erosion control.
PFI_Utilities 04-WORK SITE REPAIRS Applied Notice
Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be
reinstalled or replaced, with like kind of material. Obtain City approval of restoration work.
PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice
Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices
[MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services
Association [ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH].
PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice
Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work
area. Traffic control devices, flag persons, etc., shall be in place prior to initiation of construction work and shall be
effectively maintained.
PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice
Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The
applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and
area wide Emergency Services: 503-629-0111 (Tigard Police Dept., Tualatin Fire& Rescue) and to 503-962-8140(Tri-Met)
and 503-431-2345 (Tigard School District) and other service providers impacted by such closure.
PFI_Utilities 08-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice
Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City
approval of any access closures.
PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice
Work is permitted in daylight between the hours of 7:00 a.m. to 7:00 p.m. Mon-Fri unless otherwise authorized by the City.
PFI—Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice
Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the
City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m. to 9:00 a.m. unless authorized
by the City Engineer.
PFI_Utilities 11 -TRAFFIC CONTROL MODIFICATION Applied Notice
The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to
assure public safety.
PFI_Utilities 12- UTILITY NOTIFICATION Applied Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987.
If you have any question about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit
holder's expense.
PFI_Utilities 13- UTILITY LOCATION CONFLICT Applied Notice
Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole
before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at
the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work
with affected utility agencies.
PFI Utilities 14-TEMPORARY PATCH Applied Notice
A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance
approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is
liable for hazards or damage resulting from the prosecution of the work.
PFI—Utilities 15- REPAIR OF EXISTING FACILITIES Applied Notice
Work under this permit shall include repair of existing facilities(roads, ditches, etc.) as may be necessary, as determined by
the Inspector, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit.
Corrective work shall be done at the applicant's expense.
PFI_Utilities 16-PRECONSTRUCTION MEETING Applied Notice
Before initiating any construction activity, the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert
Phone#>, to establish a preconstruction meeting.
PFI Utilities 17- NOTICE TO COMMENCE WORK Applied Notice
The applicant shall notify the City's Inspector twenty-four(24) hours prior to commencing work, prior to any staged
inspection, and after completing work covered by the permit.
Call Ken Fisher at 503 816 6146 or Kenny@tigard-or.gov for work in Tigard right of way.
PFI Utilities 18-PERMIT/PLAN ON SITE Applied Notice
A copy of the permit including a Certificate of Insurance, and all attachments, and a copy of the approved construction plan
and all amendments shall be readily available at the work area. All work shall conform to the permit terms, conditions and
provisions and to the City approved permit plans, and approved plan amendments and to the City's standards and
specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work
performance.
PFI Utilities 19-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Utilities 20-EMERGENCY CONTACTS Applied Notice
Provide to the City inspector, in writing, the names and 24 hour emergency telephone number of two (2) persons who have
authority to resolve problems, take corrective action and, in general, will be responsible in case of any emergency. The
applicant shall notify the City Inspector; in writing, of any/all assignment changes.
PFI Utilities 21 -OTHER Applied Notice
DECEIVED {
t
f
FEB 13 2018
City of Tigard
CITY OF TIGARD
PUBLIC WORKS—ENGINEERING PLANNING/ENGINEERING i
Public Facility ImpPermitrovement (PFI) .
TYPE OF WORK
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1—Franchise Utility Work I
Check one: Utilities ❑Sidewalk/driveway approach ❑Streetimprovements performed by NWN, PGE
Detailed description: Replace bad order pole and/or utility agency.
PGE Job M2334339 ❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of
• Sidewalk installation or repair.
• Driveway approach installation
13170 SW PACIFIC HWY
Property address/location(s): and/or repair
Tigard, OR 97223 • Sanitary sewer lateral installation
and/or main line tap
Applicant: Portland General Electric[Submitted by Amy Sweany] El TYPE 3—Full scale Development
pp Work performed with Land use
Address: 10800 SW Avery Street approval which includes any of
City/state: Tualatin, OR Zip: 97062 the following:
Phone: 503-612-2935 Email: preregcoord@pgn.com • Subdivisions or Partitions f
SDPM Brandon Hadley 503-844-5412 Street�videning
Contact name: Y Phone: i
• Mainline installation for Sanitary
Contractor: NSA sewer, Storm sewer,Tiga;d water
and/or Tigard Water Service Area
CCB#: Expiration:
Address: SUBMIT COMPLETED APPLICATION TO:
City/state: Zip: City of Tigard
Planning/Engineering ,
Phone: Email: 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
Engineer:
only may be emailed to:
�A ro ermitsQtigaard-or.gov
Address: FOR STAFF USE, 0NLY
Ci state: Zip:
ry/ �
Phone: Email: Case No.:
i
Contact name: Application submittal fee(007%of
Engineers Estimate) $ _542C•M-0
Estimated value of work is required(if over$5,000):$ N/A Additional fees:$
(within the public right-of-way) Application accepted: ,
Date:
Is work related to a LAND-USE DECISION? ❑ Yes � No By: S�-
Application reviewed:
If so,please specify (MLP,SDR,SUB,etc.) case#: /
By: ./'i Date:
v
Is work related to a BUILDING PERMIT? ❑ Yes 1 No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: Date:
1:\ENG\PertnitAppifwtions\pfl appliwNon Rev.10/16/2017
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tit�kit�w' 6 w'�" PI.rxt_ C�a :L C�A.e- a4vgard • 1312WH�a�l Blvd. Tigard,�regon 97223 • wwwtigard-or.gov 503-718-2421 • Page 1 of 4
APPLICANTS
NOTE: Person specified as`!Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if
required by the city pursuant to TMC 15.041.140.
* With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,when the owner and the applicant are different
people,the applicant must be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the
owner. The owner(s)must sign this application in the space provided or submit a written authorization with this application. Franchised
Utilities are not required to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or unposed upon the subject
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
• All of the above statements and the statements in any plot plan,attaclunents,and exhibits transmitted herexvidi,are true;and
the applicants so acknowledge that any permit issued,based on flus application,may be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application.
12-111)2Qi
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property, if required.
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print naive Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov 503-718-2421 • Page 2 of4
www.invarion.com
ODOT PERMIT A ROAD
WORK
OYIMER: PRDIECT/JOBNUNMERDEVICE SPACING: A, AHEAD
N
PGE{Oregon City LCQ M233439
PROJECT NUMBER LOCATION: QTY TATE: E RIGHT LAN O
' _ _ CM/STATE: 20 CLOSED /
13170 SW Pacific Hwy mrd.Oe TA N G E N T:20' RHEA
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PRI%%coNTRAcroR:
PGE
CONTACT NAME/NUMER:
TRAFFIC LIGHT TO BE
Brandon Hadley/S034M-5412 brandon.hadley@Pgn.cnm [ TURNED OFF DURING
FLAGGiING OPERATIONS
PREPARED BY: TRAFFIC CONTROL CONTRACTOR:
C Borden Poteko Inc. °
Qa /
PUTELCO, INC
/
LEFT
TURN LANE
CLOSED
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ROAD
WORK
AHEAD x
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PREPARED
TO STOP
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WORK
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CLOSED
AHEA
All signs and devices SHALL conform to the MUTCD/OTTCH.
ROAD Will adjust to fit field conditions.
WORK
AHEA Plan NOT to scale.
19975 OVERHEAD LEGEND
345
WL 1 PL-1173: 5177 qB REMOVE/ASANDON FACILITIES_INSTALL FACILITIES
1301
install: G 197 ?,q�9C, INSTALL ADDITIONAL FACILITIESAWODIFYFACIL177ES
POLE,45'-3 79 6P�G CS G
8'SOUTHWEST2 DFI OQ R EQUIPMENT
D1806 • 66 1 WORK LOCATION
Al-L=13'-7,724#NORTHWEST 13125 OQ� P
G16-PRI-2,140#NORTHWEST GJ 13050 POLES
02 0 G16-SEC-2,925#NORTHWEST Pa POLE CLASS(1,2,3,4,H1,H2,S)
7 011 Transfer: ti
0'-4 STREETLIGHT 142 40 T
1994 ,ve. 4B' POLE HEIGHT
POLE,45-4 `'y9 6178
D8 55' �q�;r� FRAMING TRANSMISSION d DISTRIBUTION(SEE CODES BELOM
10230 D106 J SQ\/ �y� �} _FRAME DISTRIBUTION-LC10710,MU 0008
G16 grgr (1PH SGL DE,POLY)
J' Abandon: 76 481 3-142 25 T a 9960
Al 8075 �F�G pV1,K pC 1970 -((1 PH SLACK SPAN SGME N DE,-LCIPOLY)0732,MU 0106
C' PGE OWNED POLE 2 DFIR* O
yO TEMP TRANSFER COMM(S), O QP
0� PGE PULLED 2 5 5� 1723 7 GUYING
S'> TOPPED TO COMMIS) OBJ T 40-4 C2 1-02C °? 30-6 ANCHORS X X O = O = c7 0
TELCO TO PULL ,`Q'g� 1952 1978 D w o ( _ O O O
'Co 13090 13M6 W _
PG 94' (LEAD C7 J d g POS.-LBS.
O�G� 116' P0.7 ABC 112 1062 A_ (IBS) � � � � N 2GUYS G2 GS GB G11 GI rL I GUY G1 G4 G7 G1 G �
PpG Anchor Code Al A3 AS A7 A8 3 GUYS
G3 G6 G9 G1 GI G21
1�t45 PO�A6p�G
O
C" LANDSCAPING NOTES
1 2s CUT CONCRETE d
oG e ?os° REPAIR FOR
9� \POLE REPLACEMENT
1316s
103'
32010 x•1;0
885970 45'-4
2 DFIR 1952
01 RC�9 30 60 120 Feet ABCN 2 ACSR
1421 3-14210 T - rx N
THINK PGE CONSTRUCTION DRAWING
SAFETY AS-BUILT VERIF/CAT 1
FIRST Foreman Date:
General Foreman: Date:
(Signature ony required for Oeld constniction changes)
SDPIAIENG REVIEW SBUILT BY DESIGNER.'
NY DEVIATION FROM THIS DESIGN MUST ro 0
11/9/2017 1 in=60 ft 1070001 0000017443 M2334339
aBEAPPROVED BY THE PGE PROJECT MANAGER
-- 2016 OH FITNES-REPLACE B/O POLE
CIRCUIT SIZE
ATTENTION: CALL 811 BEFORE YOU DIG / TIGARD-TIGARD 13 11 x 17
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED ' �,/�� LOCATION
BY THE OREGON UTILITY NOTIFICATION CENTER. 13170 SW PACIFIC HWY,TIGARD,OR,97223
THOSE RULES ARE SET FORTH 1N OAR 957-001-0010 DESCRIPTION
THROUGH 952-001-0090 YOU MAY OBTAIN COPIES OF REPLACE 45'-4 POLE WITH 45'-3 SHEET
THE RULES BY CALLING THE OREGON UTILITY COUNTY SECTIONS WORK WTH
NOTIFICATION CENTER ADMINISTRATION @(502-232-1987) WASHINGTON C2102C 1 OF 1
TO REQUEST UTILITY LOCATES CALL THE OREGON Koowr�arsb�lovll• MLSo"VrLLe DESIGN BY PHONE DRAWNBY
UTILITY NOTIFICATION CENTER,811 AT LEAST Call betomyoudig. LMec"ewcr"nr" BRANDON HADLEY 503.758.6436 1 SARA MCCAUGHAN
2 BUSINESS DAYS PRIOR TO EXCAVATION90 WSW BOECKMANRD
Wn NVILLE.OR 97070 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED
Samuel Copelan
From: Prereq Coord <PreregCoord@pgn.com>
Sent: Thursday, February 15, 2018 7:14 AM
To: Samuel Copelan
Cc: Prereq Coord
Subject: RE: NEW City of Tigard Permit Application, 13170 SW PACIFIC HWY, PGE Job M2334339
Follow Up Flag: Follow up
Flag Status: Flagged
Thanks, Linda.
Samuel, thank you for the ODOT Permit memo below. The ODOT Permit had been applied for and received prior to our
Permit Application to the City of Tigard.
The ODOT Permit is 2BM42274 and expires 6/1/18.
Thank you for all that you do,
Amy Sweany
GE Administrative Assistant PSLD • 503-612-2935 • 503-612-6150
�f)
10800 SW Avery Street Tualatin, OR 97602
PortlandGeneral.com • Follow us on social @PortlandGeneral
From: Prereq Coord
Sent: Thursday, February 15, 2018 6:37 AM
To: Samuel Copelan
Cc: Amy Dee Sweany
Subject: RE: NEW City of Tigard Permit Application, 13170 SW PACIFIC HWY, PGE Job M2334339
I have paid for this online. O
L� x(l.Sad 2Rx
'CIE Prerequie1Ccxwd4*wWu w
(503) 612-6103
Com' (9 71) 371 -0201
.,
PGE
From: Samuel Copelan [mailto:samuelc@tgard-or.gov]
Sent: Wednesday, February 14, 2018 4:19 PM
To: Prereq Coord; ROW Permits
Cc: Brandon Hadley; Kenny Fisher
Subject: RE: NEW City of Tigard Permit Application, 13170 SW PACIFIC HWY, PGE Job M2334339
'Please take care when opening links, attachments or responding to this email as it originated
outside of PGE.'**
Good evening,
This job will also require an ODOT permit, since traffic control will be on Highway 99W. Please communicate with ODOT
regarding their permitting process.
Your permit is ready for $300.00 fee payment. You can pay the fee online by clicking this link:
httns://aca.accela.com/tigard/, go to the "Engineering" tab, search for record number PFI2018-00035
Then, go to the "Payments" tab and click "Fees" to submit your online payment. Please notify us once
you've paid, and we can release the permit.
Thank you,
City of Tigard
Public Facility Improvement (PFI) Permits
Phone: (503) 718-2421
E-mail: rowWermits o,ti ar�gov
From: Prereq Coord [mailto:PreregCoord@pgn.com]
Sent: Tuesday, February 13, 2018 7:00 AM
To: ROW Permits <rowpermits@tigard-or.gov>
Cc: Brandon Hadley<Brandon.Hadley@pgn.com>; Prereq Coord <PreregCoord@pgn.com>
Subject: NEW City of Tigard Permit Application, 13170 SW PACIFIC HWY, PGE Job M2334339
Good morning.
Attached is the City of Tigard Permit Application, Job Sketch, and TCP Package for PGE Job M2334339. We already have
an approved permit from ODOT as well.
Please contact SDPM Brandon Hadley at 503-844-5412 with any questions.
Thank you for all that you do.
0/1pr r_ Amy Sweany
Administrative Assistant, PSLD • 503-612-2935 • 503-612-6150 (fl
10800 SW Avery Street Tualatin, OR 97602
PortlandGeneral.com • Follow us on social @Portland General
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
2